Umbilical hernia has gained little attention from surgeons in comparison with other types of abdominal wall hernias (inguinal, postoperative); however, the primary suture for umbilical hernia is associated with a recurrence rate of 19–54%. The aim of this study was to analyze the results of the umbilical hernia repair and to assess the independent risk factors influencing umbilical hernia recurrence.
Materials and methods. A retrospective analysis of patients who underwent surgery for umbilical hernia in the Hospital of Kaunas University of Medicine in 2001–2006 was performed. Age, sex, hospital stay, hernia size, patient’s body mass index, and postoperative complications were analyzed. Postoperative evaluation included pain and discomfort in the abdomen and hernia recurrence rate. The questionnaire, which involved all these previously mentioned topics, was sent to all patients by mail. Hernia recurrence was diagnosed during the patients’ visit to a surgeon. Two surgical methods were used to repair umbilical hernia: open suture repair technique (keel technique) and open mesh repair technique (onlay technique). Every operation was chosen individually by a surgeon. Results. Ninety-seven patients (31 males and 66 females) with umbilical hernia were examined. The mean age of the patients was 57.1±15.4 years, hernia anamnesis – 7.6±8.6 years, hospital stay – 5.38±3.8 days. Ninety-two patients (94.8%) were operated on using open suture repair technique and 5 (5.2%) patients – open mesh repair technique. Only 7% of patients whose BMI was >30 kg/m2 and hernia size >2 cm and 4.3% of patients whose BMI was <30 kg/m2 and hernia size 0.05). The rate of postoperative complications was 5.2%. Sixty-seven patients (69%) answered the questionnaire. The complete patient’s recovery time after surgery was 2.4±3.4 months. Fourteen patients (20.9%) complained of pain or discomfort in the abdomen, and 7 patients (10.4%) had ligature fistula after the surgery. Forty-five patients (67.2%) did not have any complaints after surgery. The recurrence rate after umbilical hernia repair was 8.9%. The recurrence rate was higher when hernia size was >2 cm (9% for 2 cm) and patient’s BMI was >30 kg/m2 (8.6% for < 30 vs 10.7% for >30). There were 5 recurrence cases after open suture repair and one case after onlay technique. Fifty-six patients (83.6%) assessed their general condition after surgery as good, 9 patients (13.4%) as satisfactory, and only 2 patients (3%) as poor.
Conclusions. We did not find any significant independent risk factors for umbilical hernia recurrence. However, based on reviewed literature, higher patient’s body mass index and hernia size of >2 cm could be the risk factors for umbilical hernia recurrence.

Ventral hernia is a common problem in general surgery practice. Incisional hernia can develop in 15–25% of patients after abdominal surgery. The aim of this study was to compare two different methods of incisional hernia surgery. Materials and methods. A retrospective analysis of database of surgery department from 1997 to 2000 was performed. All patients were divided into two groups. The first group patients were operated using open suture repair (keel technique); the second group patients – using open mesh repair (onlay technique). Long-term follow-up was done by a mail questionnaire. A special questionnaire was sent to all patients. Postoperative evaluation included pain and discomfort in the abdomen, physical activity, and recurrence rate after operation. Statistical evaluation was conduced using descriptive analysis: the unpaired Student t test to compare parametric criterions between two study groups, Mann-Whitney U test to compare the unpaired nonparametric criterions between two study groups, and _X² test to investigate nonparametric criterions between these groups.
Results. A total of 202 patients (51 males, 151 females) with incisional hernia were operated during 1997–2000. One hundred seventy-one patients were in the keel technique group, and 31 patients in the onlay technique group. There were no significantly differences in age and sex between these groups. The hospitalization time was significantly longer in the open mesh repair group. The postoperative complication (wound seroma and suppuration) rate was significantly higher in the onlay technique group. One hundred sixty-one patients (79.7%) answered the questionnaire (133 in the keel technique group, 28 the in onlay technique group). The patients’ return to physical activity after surgery was significantly longer in the keel technique group. Forty-one patients (31%) had hernia recurrence in the keel technique group and 3 patients (11%) in the onlay technique group (P<0.05). There were no postoperative deaths in both groups. Conclusions. The rates of postoperative therapeutic complications and hernia recurrence are significantly lower after open mesh repair surgery. Return to normal physical activity after surgery is significantly longer after open suture repair surgery.

Background and objective: Rectus sheath haematoma (RSH) is an uncommon condition that may vary from contained haematoma to life-threatening bleeding. Timely diagnosis and treatment is crucial in this patient population. The aim of the current study was to investigate the results of the different RSH treatment strategies among patients admitted to a surgery department. Materials and methods: A retrospective analysis of 29 patients treated for RSH in surgery departments of two medical centres from 1 January 2007 to 30 September 2017 was conducted. The patient’s age, sex, ASA (American Society of Anesthesiologists; physical status classification system), use of anticoagulants, cause of haematoma, radiological data, vital signs, blood investigations, and type of treatment were extracted. The results were analysed according to the type of treatment. Results: The patients’ mean age was 67.6 ± 14.3 years, and the mean duration of in-hospital stay was 10.7 ± 6.7 days. All patients were on anticoagulant treatment, and 82.8% of them had spontaneous haematoma. Nine patients (31%) needed transfusion of packed red blood cells with an average of 2.6 units (range: 1–4). Five patients (17.2%) presented with symptoms and signs of hypovolemic shock, and four of them underwent embolisation. Embolisation was successful in all cases. Open surgery was performed in 6 patients, 8 patients underwent percutaneous drainage, and 10 patients were treated conservatively. Two patients (6.7%) died in our series. Both of these patients had type III RSH. Patients in the conservatively treated group had the shortest hospital stay. There were no readmissions due to repeated haematoma or infection. Conclusions: Embolisation of epigastric arteries is a useful tool to stop bleeding into RSH in patients with unstable haemodynamics. Conservative treatment is comparable to ultrasound (US) drainage of RSH but results in a shorter hospital stay. Type III RSH is associated with a higher death rate.

Mucinous adenocarcinoma in association with chronic anal fistula is a rare case in clinical practice. The aim of this article was to report a rare case of anal gland mucinous adenocarcinoma in a patient who was treated in the Hospital of Kaunas University of Medicine. Case report. A 70-year-old male was treated for anorectal fistula in the surgical department. Four operations were performed for perineal abscess during the period of 15 years. During the period of 15 years, the patient complained of purulent secretion from the perineal abscess. After the last operation, anorectal fistula developed. Multiple biopsies and scrapings of the fistulous track were taken for histological examination. Histological examination revealed mucinous adenocarcinoma, G2. Subsequently, the patient underwent endoanal ultrasound, computed tomography scan, and colonoscopy. The computed tomography scan did not show pathology in the abdomen, but showed soft tissue induration at the site of anorectal fistula. Colonoscopy investigation did not show any pathology in the rectum and bowels. Endoanal ultrasound findings showed soft tissue induration at the site of anorectal fistula, no tumor in the rectum wall. The patient underwent abdominoperineal resection. Histological examination after abdominoperineal resection revealed anal duct mucinous adenocarcinoma pT2 N0 L0 V0 R0, G2. Metastases to the mesenteric lymph nodes were not detected. On the eight day after abdominoperineal resection, the patient was discharged from the hospital for follow-up. Summary. Mucinous adenocarcinoma in anorectal fistula is a rare condition. If surgical treatment for perineal abscess or anorectal fistula is not successful for a long time, mucinous adenocarcinoma should be suspected.

The aim of our experimental biomechanical study was to compare the strength of two different midline laparotomy suture techniques: simple suture and reinforced tension line (RTL) suture. Materials and methods : Sixty midline laparotomies on cadavers were performed: simple and RTL sutures in each 30 cases. Cadavers were patients who died in the hospital during the last 24 hours and had no previous abdominal operations and no arterial aneurysm disease. Simple and RTL sutures were made with slowly absorbable polydioxanone (PDS II loop, 1/0 size). The strength of both sutures was measured with tensiometer and expressed in Newton (N). The maximal suture strength was assessed at the moment when the suture tore the tissues. Results : The simple suture strength was significantly lower than RTL suture strength (86.3 ± 16.8 N vs. 113 ± 16.6 N, p < 0.001). The midline laparotomy suture strength increased up to 31% when RTL suture was performed. The RTL suture strength was significantly higher in all three abdomen regions: epigastric (80 ± 15.7 N vs. 106.6 ± 14 N, p < 0.001), umbilical (86.2 ± 16 N vs. 112.9 ± 14.8 N, p < 0.001) and hypogastric (93.7 ± 17.2 N vs. 120.7 ± 18.1 N, p < 0.001). Conclusions : The reinforced tension line suture is significantly stronger than simple suture when closing the midline laparotomy. This suture can be used in patients with higher fascia dehiscence or incisional hernia risk.